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Individual
MR. THOMAS BERNARD PETTUS
Active
Individual
MR. THOMAS BERNARD PETTUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLPC, LBS.W.
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401008172
MI
104100000X
Social Worker
6802061866
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401008172
ST OF MI-COUNSELING LICENSE
MI
01
—
6801061866
STATE LICENSE
MI
Enumeration date
08/31/2006
Last updated
06/25/2014
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